Sunday, July 18, 2010

Grocery Carts and Call Waiting: Why I'll Make A Good Doctor

The title of my blog is, obviously, "My Bedside Manner." So far, though, I haven't done much talking about my own bedside manner. Mostly because I haven't had much of a chance (aside from the summer I spent working in an ICU back in 1999) to develop one, officially speaking.

That doesn't mean, though, that I haven't thought about it. In fact, I've thought about it a great deal. And I've come to the conclusion that, in all likelihood, my initial bedside manner won't be so bad. It might even be a tad bit good. And hopefully, it will get even better as time goes on.

How did I come to this conclusion? It all started with my grocery cart dilemma. I was at the local Mexican produce market and had just finished loading my trunk with fresh fruit and vegetables for the week. I had parked about as far away as possible (not on purpose, believe me), and it was at least a sun-blazing 90 degrees outside. So when I saw a cluster of about a dozen other shopping carts circling a streetlamp in the parking lot, I was sorely tempted to wheel mine into the bunch rather than back to the storefront. But then I sighed, realizing that I am not the kind of person who leaves the grocery cart in the middle of the parking lot. It just feels wrong to me somehow, unnatural. I would have driven away feeling guilty, and I didn't want that. So I marched off toward the store, cart in tow.

After my sweaty walk back to the store, I returned to my car and switched on the AC. As I sat waiting for the hot blasts of air to cool down, it occurred to me that my reaction to the cart dilemma might say something about me as a person. It might indicate that I can be thoughtful, even when I don't know who will benefit from my thoughtfulness. That I don't like to make extra work for other people if I can help it. That I have a sense of responsibility, and that I take things seriously even when so many people around me (i.e., the other customers) do not.

OK, I will come clean: I am far from perfect. I do not always take the cart back. But I tend to. And so I think what I have just said has some validity.

I got to thinking more about that tendency to take the cart back. Not only what it might mean about me as a person, but also what it might mean for the kind of bedside manner I will have. Thoughtfulness, pitching in where needed, a sense of responsibility? These sound like components of a decent bedside manner to me, as well as a recipe for getting along with my future hospital or clinic co-workers.

"Are there any other clues as to my future bedside manner?" I wondered to myself. Driving home, I thought through some of my other habits (my husband would be more likely to call them "quirks," but then again he's allowed that privilege). Of course everyone has habits, but I was looking for habits linked to my ability to relate to others (especially strangers), and to care for them. Sure as Sherlock, I found my clues.

"Eva." She was my first clue. I don't imagine she gets called "Eva," which is her real name, very often during the 9-to-5 workday. But when I stop by the Student Union at the University of Illinois at Chicago for coffee, I do call my barista by her given name. We exchanged names a few weeks ago, and have had little chats ever since. (I've had to remind her of my name several times, which is fine--she has dozens of customers every day; I have only one barista.) I don't pretend that I've solved all the problems in her life, but I do believe that I've shown her the respect she deserves, but doesn't often get because she's working an "unskilled labor" job (and is surrounded by hoity-toity doctors who are more than happy to point that out).

In a hospital setting, that would translate into exactly the same thing: learning people's names, and using them. Rather than, for example, calling someone "the gall bladder in 241" or "the stroke in 332." Yeah, not much respect for the person there. Learning someone's name shows that you care about them as an individual person, and (in the hospital) not just about their disease or what kind of health insurance they have. That's pretty important for building the patient-doctor relationship.

Using a person's name is one important aspect of communication. Another is saying "thank you" when someone deserves it. Of course, when you're at the grocery store, most people say "thank you" when the bagger hands over the plastic sacks. I'm not talking about those automatic situations. I'm talking about going out of your way to thank someone, where it really makes them feel special and rewards extra effort.

I have found that this really goes over well with people. Although that's not why I do it. I do it, perhaps, because I like being thanked. Or maybe because my mom forced my sisters and I to write thank-you notes for every little gift we ever received as children, so it's ingrained in my head now. Regardless, I do it. Like when I was at the craft store the other day. The cashier rung something up as regular price. I thought it was on sale. Rather than tell me to go find another item with a more accurate tag, or call someone else to check on it, she went over to the shelf herself. Turns out, she was right. Regardless, I thanked her for making the extra effort to verify the price for me. She smiled, and I think she even blushed.

In the doctor-patient relationship, it's the doctor who's helping the patient, and who should be thanked. So my habit doesn't apply. Right? I wholeheartedly disagree. In any relationship, there is give-and-take. One has to help the other, and vice versa. Sure, the patient has come to the doctor looking for help, and it would be nice if the patient thanked the doctor, but that's not why the doctor does his or her job. However, the doctor can make his or her job a bit easier by saying "thank you" to the patient. This may not work in all situations, but it will in many. For example, a patient reveals something very personal that was difficult to say, but necessary to treating a condition. "Thank you," says the doctor. Or the patient comes early as requested to fill out some paperwork. "Thank you," says the doctor. You get the idea. The obvious corollary of this is for the doctor to say "I'm sorry" when he or she has done something wrong, is running late, etc. Both appreciation and apology go a long way toward building a relationship with someone, and maintaining that relationship. This is the philosophy I have developed so far, and the one I intend to implement in the future.

A common thread here so far has clearly been respect. So if I want to have a good bedside manner, I want to avoid disrespect (this is obvious, but bear with me). One of the most disrespectful inventions in the history of man, in my opinion, is telephone call waiting. It has its purpose, I understand. And I use it from time to time--but ONLY if I am expecting a particular telephone call, and one that is extremely urgent. If I am talking to someone, and another person calls, that second person can either leave me a voicemail message or call me back later. End of story. Because I consider it in very poor taste to interrupt my first conversation to (ostensibly) find out whether the second call is more important, and should therefore be given priority. This call waiting fetish says much about the "NOW" need in our culture, but I will not go into that. Suffice to say I ignore my call waiting 95 percent of the time.

OK, I admit, this one won't work in the physician setting. If, as a doctor, I am on the phone with a patient, I may very well get a phone call from someone else (another patient, the hospital, a resident, etc.) that may very well be urgent, but I won't know that until I find out who it is or what it is about. So I will have to make some philosophical adjustments here.

However ... my principal still holds in another respect: respecting a person's time. (Because when you break it down, that's a large component of the problem with call waiting. You're saying one person's time is more valuable than another's.) For example, if a physician is talking to a patient, that physician should, whenever possible, give his or her full attention to that patient. Doctors filling out patient charts while they talk to a different patient about a potentially life-threatening condition, and having to ask that patient to repeat things because the doctor was busy writing something down on the chart? That's not respectful. That's just like saying, "I've got another phone call. Hold on." Again, there will be plenty of urgent, and warranted, interruptions. That goes with medicine. So make those five minutes, if that's all you've got, count. That's my plan, at least.

Along with paying attention, there's another aspect to respecting a person's (and a patient's) time. That is running on time. Also not always possible, clearly, due to those aforementioned interruptions, emergencies, and so on. But I have seen a number of different medical practices at work--some run efficiently, others not so much. There are ways to running closer to being on time. Those ways sometimes cost money (i.e., salary for additional staff to process patients or shelf charts). But if your patients are happy, they are more likely to come back and pay you again. And if you, your patients' doctor, is on time, your patients are more likely to be happy. Because their time is valuable, too. Having sat in more waiting rooms than I'd care to think about, I heartily and readily acknowledge this.

None of this is to say that I am extra special, am grandly talented when it comes to interpersonal affairs, am a superhero, or am the next Dr. Schweitzer. Nothing of the sort. I'm just saying that these habits, which really (so far) have nothing to do with medicine, illustrate that I respect people in various ways and that I am willing to put myself in their shoes to make sure that respect comes across. And that, to me, is at least part of what having a good bedside manner is about.

Thanks, Sarah! I'm hoping to do a little bit of both (doctoring and writing). Are you familiar with Oliver Sacks? He's a world-famous neurologist who also writes fantastic books (narratives and reflections about what the medical community calls "zebras" -- interesting and bizarre cases). He is an amazing doctor, and also an amazing writer. His most famous book is "The Man Who Mistook His Wife For A Hat," which I highly recommend. He has written many others as well, and I've read a couple. Once I start actually working with patients, I hope to do some of that myself -- writing about my experiences. I'll do it on my blog, at the least. And who knows, maybe my stuff will turn into a book someday!